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Organization
TX SOUTHERN DENTAL PPO PC
Active
Organization
TX SOUTHERN DENTAL PPO PC
Active
Parent organization
TX SOUTHERN DENTAL PPO PC
Other names
Bay Area Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
TX SOUTHERN DENTAL PPO PC
Authorized official
ERIKA MELISSA MENJIVAR (SR. CREDENTIALING SPECIALIST)
(469) 596-6137
Entity
Organization
Contact information
Practice address
6011 W MAIN ST STE A101, LEAGUE CITY, TX 77573-7541
(281) 338-6559
Mailing address
5830 GRANITE PKWY STE 780, PLANO, TX 75024-6775
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
09/25/2024
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